Clinical Features of Asymptomatic SARS-CoV-2 Infection in Hemodialysis Patients

Abstract

<b><i>Background:</i></b> CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. <b><i>Objective:</i></b> To analyze the clinical spectrum of COVID-19 on hemodialysis patients. <b><i>Method:</i></b> A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. <b><i>Results:</i></b> COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (<i>p</i> = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). <b><i>Conclusions:</i></b> Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

“…In research articles reporting clinical manifestation and outcome of COVID-19 patients (78[54.4%]) the diagnosis of SARS-CoV-2 infection relied principally on RT-PCR (52[63.4%]) [ 11 – 20 , 32 , 61 , 62 , 69 , 93 , 94 , 100 , 108 – 111 , 113 , 115 – 124 , 126 , 129 , 132 , 134 , 135 , 138 – 151 ], serology (4[6.3%]) [ 18 , 20 , 22 – 24 , 86 , 99 ], RT-PCR and serological assay (5[6.6%])[ 29 – 31 , 85 , 127 , 152 ] or a combination of diagnostic tests including clinical evaluation [ 6 , 13 , 19 , 21 , 112 , 114 , 125 , 128 , 130 , 131 , 133 , 136 , 137 , 153 , 154 ].…”

“…All outcome measures were influenced by the sample size, the age of patients, length of follow-up and policy of healthcare delivery. Excluding studies reporting outcome of patient admitted to hospital as a preventive measure and regardless of symptoms, we found that hospitalization of HD patients varied from 35 to 88.2% [ 11 – 13 , 17 , 21 , 32 , 62 , 82 , 93 , 109 , 114 , 116 , 118 , 120 , 127 , 129 , 133 , 136 – 138 , 144 , 145 , 150 , 154 ]. with a percentage of patients requiring ICU admission of 2.6–70.5% [ 6 , 13 , 17 , 21 , 32 , 62 , 109 , 114 , 116 , 118 , 119 , 121 , 125 , 126 , 129 – 134 , 136 , 138 , 143 , 154 ].…”

“…Age of confirmed COVID-19 patients on HD was largely heterogeneous since principally tends to reflect national policy of access to dialysis treatment. Median and mean age of this large cohort of patients ranged between 48 and 79.5 years [11,15,17,21,23,61,82,94,[108][109][110][111][112][113][114][115][116][117][118][119][120][121][122] and 54.1-76 years, [6,19,25,31,32,69,93,[123][124][125][126][127][128][129][130][131][132][133][134][135] respectively. The percentage of male was 37.5%-100% of the examined population [11,13,15,17,19,…”

Lung ultrasound may help in the differential diagnosis of suspected oligosymptomatic COVID‐19 patients on hemodialysis: A case report

“…4,5 In fact, an asymptomatic or oligosymptomatic form of SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. 12 LUS may help to screen and early diagnose COVID-19 pneumonia in different settings, particularly in areas with high rates of community transmission. 7 We would propose to expand this approach to different settings characterized by frequent contact with healthcare facilities and other patients, and high comorbidity burden (such as emergency departments, hemodialysis centers, nursing homes, transplant outpatients clinic).…”

Home dialysis and Covid-19 in french speaking countries (RDPLF data-base)

“…La proportion de patients contaminés à domicile est probablement plus faible car nous n'avons pas demandé aux centres d'enregistrer les patients asymptomatiques : un testing systématique dans 66 centres d'hémodialyse en Espagne a montré que 13 % des patients avec un test PCR positif étaient asymptomatiques [4].…”